It’s time for a Texas pivot on health care

Next up, Texas must flip-flop on Obamacare.

by Mitchell Schnurman

Source: Dallas Morning News

After ripping health reform for years and rejecting Medicaid expansion last month, we now have to persuade millions of Texans to embrace the law and put their own money behind it.

The next health care wave — the launch of online insurance exchanges — is scheduled for this fall. And Texas has much riding on it.

About 3 million uninsured residents will get access to coverage and federal subsidies to help pay premiums. If about half take up the offer, we’d make a big dent in the uninsured and $6 billion in annual subsidies would flow into Texas by 2016, the state estimated.

Having health insurance would be good for families, whether it’s to improve their health, financial security or peace of mind. It would also be a boost for taxpayers, doctors, hospitals and those who have insurance (and pay higher premiums to help foot the bill for those without it).

But this will be a tough sell. Many don’t believe they can afford health coverage, even with help. Others don’t believe they need it because they feel young and invincible. And some reject it as a Washington debacle, a view reinforced by the hostility in Texas and much of the country.

Last month, after steady pressure from the governor, the Legislature rejected the expansion of Medicaid as part of the health law. That would have covered about a million low-income adults in Texas and pumped billions in federal dollars into the economy. The state would have matched only a fraction of the costs.

If Texas leadership won’t accept federal dollars to cover the state’s most vulnerable citizens, how will individuals be persuaded to step up and do the right thing? And how will advocates counter the constant attacks on Obamacare?

“We’re all wrestling with that,” said Stephen Mansfield, CEO of Methodist Health System in Dallas. “Either you put your head in the sand and wish for a better life or do what you can do. We’re going to keep plugging away at it.”

In Texas, they’ll have to change minds, not just educate the public. So look for a major publicity effort from area hospitals, Blue Cross Blue Shield, local government leaders, faith groups, and community and national organizations. Last week, the Texas Organizing Project canvassed homes in Dallas to hone its message.

Hospitals will encourage sign-ups, and they already have advisers to steer patients through the coverage maze. The exchanges’ open enrollment period will last from October to March. So when uninsured patients show up in the emergency room, they may have real payment options, although executives warn that many details are still unknown.

Advocates are tamping down expectations. New programs often have a shaky start. Nationwide, the child insurance program started small and, after five years, had a large population. When Medicare expanded prescription drug coverage, the complexity drew complaints.

Navigating the online exchanges is likely to be more confusing. They’ve been portrayed as a Travelocity for health insurance, but the rules and paperwork will be immense. The subsidies, a key feature, will vary widely, depending on income, family size and coverage.

“This is a huge set of changes,” said Barclay Berdan, chief operating officer for Texas Health Resources, who predicts many challenges. “We’re not expecting a big ‘aha’ moment.”

Assistance will be on a sliding scale, available to people earning up to four times the federal poverty level. But Texas applicants whose earnings fall below the poverty line ($23,550 for a family of four) will usually get no help at all. They were supposed to be covered by Medicaid.

Gov. Rick Perry fought that idea and chose to not create a state health exchange, leaving that to the feds. While state agencies aren’t expected to push enrollment, they should reconsider.

“Let’s make an economic decision,” said John Goodman, CEO of the National Center for Policy Analysis in Dallas and a critic of Obamacare. “If the federal government is offering money for private insurance, take it.”

He said Texas should get aggressive in pushing the case. Food stamps could be withheld, he said, and tax refunds could be linked to enrollment.

Dallas County Judge Clay Jenkins compared this to other campaigns, such as an employer’s retirement plan or applying bug spray to avoid the West Nile epidemic.

“There’s a big difference between just throwing out a plan and really pushing it,” Jenkins said.

The cost of uncompensated care in Dallas tops half a billion dollars annually, he said. That number would decline if more people had insurance, and the benefits would grow if people’s health improved.

Other states are expanding Medicaid and developing exchanges. California and Oregon have had early success, and Jenkins said that if trends continue, Texas could be at a competitive disadvantage.

The state has missed one chance to slash its uninsured, probably until the next biennium. Now it has another.